Median Width Research Articles

First Report of Northern Root-Knot Nematode Meloidogyne hapla on Codonopsis pilosula in China

Worldwide, root-knot nematodes are among the most important plant-parasitic nematodes infecting and causing yield losses on many important plant species. They can cause extensive galling on plant roots, leading to serious economic losses (Azevedo de Oliveira et al. 2018). Codonopsis pilosula is used extensively in traditional Chinese herbal medicine and is a major economic crop in Gansu province. In the summer of 2019, a survey for plant-parasitic nematodes was conducted in Gansu province, northwest China. During the survey, 35 out of 76 fields of C. pilosula had plants exhibiting stunting, decline, and extensive galling on the secondary and tertiary roots. These are typical symptoms of infection by root-knot nematodes. Females, males, J2s, and eggs collected from roots of C. pilosula had the following morphometric characters: the perineal pattern of females (n = 10) were round-shaped, with low dorsal arches and small punctations near the anus, lateral line marked. Females (n = 20): body length (L) = 579.06 ± 50.19 μm (511.42 to 677.41 μm), maximum body width (W) = 423.81 ± 29.11 μm (396.72 to 467.41 μm), stylet length = 9.93 ± 0.88 μm (8.71 to 11.72 μm), distance from dorsal esophageal gland opening to the stylet knot (DGO) = 4.93 ± 0.42 μm (3.91 to 5.84 μm), stylet median bulb width (MBW) = 29.67 ± 3.61 μm (24.41 to 35.31 μm). Males (n = 10): L = 1,021.75 ± 106.38 μm (885.09 to 1,230.52 μm), stylet length = 17.15 ± 1.41 μm (15.27 to 19.89 μm), DGO = 5.04 ± 0.61 μm (4.24 to 5.83 μm), MBW = 9.82 ± 2.09 μm (7.11 to 14.24 μm), spicule length = 21.97 ± 1.67 μm (19.54 to 24.59 μm). J2s (n = 20): L = 363.66 ± 25.96 μm (322.41 to 398.88 μm), a = 24.41 ± 4.32 (21.33 to 27.12), stylet length = 10.41 ± 0.79 μm (9.01 to 11.32 μm), DGO = 4.01 ± 0.56 μm (3.22 to 5.13 μm), tail length = 53.15 ± 10.56 μm (32.74 to 71.24 μm). Eggs (n = 20): L = 73.92 ± 4.35 μm (68.43 to 80.13 μm), W = 25.19 ± 3.94 μm (20.48 to 30.74 μm). These morphological characteristics are consistent with Meloidogyne hapla Chitwood, 1949 as described by Whitehead (1968). Molecular analysis was conducted for further research; DNA was isolated from four individual females, and then the ITS region and D2/D3 region of 28S were amplified with primers18S/26S (Vrain et al.1992) and D2A/D3B (Al-Banna et al. 2004), respectively. The D2/D3 region of 28S sequence and ITS sequence were deposited in GenBank under accession numbers MN752204 and MN752202, respectively. D2/D3 region of 28S sequence was 99.84 to 99.91% identical to those of M. hapla from China (KJ755187), Myanmar (MN446015), and Japan (KF430798). The ITS region sequence was 99.31 to 99.61% identical to several sequences of M. hapla from GenBank, including ones from Spain (MH011978), Taiwan (KJ572385), the United States (AY268108), and Japan (LC030357). Furthermore, species identification was also confirmed using PCR to amplify with M. hapla-specific primers Mh-F/Mh-R (Feng et al. 2008). An expected PCR fragment of approximately 462 bp was obtained, which was consistent with M. hapla reported. No amplification products were observed in the control. A pathogenicity test of this M. hapla population was carried out in a growth chamber maintained at 20 to 25°C. Eight healthy C. pilosula seedlings were transplanted into plastic pots (one plant per pot). After 2 weeks, the roots of six plants were inoculated with 3,000 J2s and eggs per root system, and two uninoculated plants were used as a control. After 65 days, all inoculated plants exhibited yellowish leaves and stunting and had extensive galling on roots, which resembled those on field-grown plants. No galling or symptoms were observed on control plants. The final population density was quantified, and mean nematode reproduction factor (final population/initial population) was 4.3. These results confirm this root-knot nematode population on C. pilosula is M. hapla. To our knowledge, this is the first report of M. hapla in Gansu province and the first report of C. pilosula as a new host of M. hapla.

Stratocumulus cloud clearings: statistics from satellites, reanalysis models, and airborne measurements.

This study provides a detailed characterization of stratocumulus clearings off the US West Coast using remote sensing, reanalysis, and airborne in situ data. Ten years (2009–2018) of Geostationary Operational Environmental Satellite (GOES) imagery data are used to quantify the monthly frequency, growth rate of total area (GRArea), and dimensional characteristics of 306 total clearings. While there is interannual variability, the summer (winter) months experienced the most (least) clearing events, with the lowest cloud fractions being in close proximity to coastal topographical features along the central to northern coast of California, including especially just south of Cape Mendocino and Cape Blanco. From 09:00 to 18:00 (PST), the median length, width, and area of clearings increased from 680 to 1231, 193 to 443, and ~ 67000 to ~ 250000km2, respectively. Machine learning was applied to identify the most influential factors governing the GRArea of clearings between 09:00 and 12:00PST, which is the time frame of most rapid clearing expansion. The results from gradient-boosted regression tree (GBRT) modeling revealed that air temperature at 850 hPa (T850), specific humidity at 950 hPa (q950), sea surface temperature (SST), and anomaly in mean sea level pressure (MSLPanom) were probably most impactful in enhancing GRArea using two scoring schemes. Clearings have distinguishing features such as an enhanced Pacific high shifted more towards northern California, offshore air that is warm and dry, stronger coastal surface winds, enhanced lower-tropospheric static stability, and increased subsidence. Although clearings are associated obviously with reduced cloud fraction where they reside, the domain-averaged cloud albedo was actually slightly higher on clearing days as compared to non-clearing days. To validate speculated processes linking environmental parameters to clearing growth rates based on satellite and reanalysis data, airborne data from three case flights were examined. Measurements were compared on both sides of the clear–cloudy border of clearings at multiple altitudes in the boundary layer and free troposphere, with results helping to support links suggested by this study’s model simulations. More specifically, airborne data revealed the influence of the coastal low-level jet and extensive horizontal shear at cloud-relevant altitudes that promoted mixing between clear and cloudy air. Vertical profile data provide support for warm and dry air in the free troposphere, additionally promoting expansion of clearings. Airborne data revealed greater evidence of sea salt in clouds on clearing days, pointing to a possible role for, or simply the presence of, this aerosol type in clearing areas coincident with stronger coastal winds.

Elevated ionizing photon production efficiency in faint high-equivalent-width Lyman-α emitters

ABSTRACT While low-luminosity galaxies dominate number counts at all redshifts, their contribution to cosmic reionization is poorly understood due to a lack of knowledge of their physical properties. We isolate a sample of 35 z ≈ 4–5 continuum-faint Lyman-α emitters from deep VLT/MUSE spectroscopy and directly measure their H α emission using stacked Spitzer/IRAC Ch. 1 photometry. Based on Hubble Space Telescope imaging, we determine that the average UV continuum magnitude is fainter than −16 (≈ 0.01 L⋆), implying a median Lyman-α equivalent width of 259 Å. By combining the H α measurement with the UV magnitude, we determine the ionizing photon production efficiency, ξion, a first for such faint galaxies. The measurement of log10 (ξion [Hz erg−1]) = 26.28 ($^{+0.28}_{-0.40}$) is in excess of literature measurements of both continuum- and emission line-selected samples, implying a more efficient production of ionizing photons in these lower luminosity, Lyman-α-selected systems. We conclude that this elevated efficiency can be explained by stellar populations with metallicities between 4 × 10−4 and 0.008, with light-weighted ages less than 3 Myr.

Extraction of Yardang Characteristics Using Object-Based Image Analysis and Canny Edge Detection Methods

Parameters of geomorphological characteristics are critical for research on yardangs. However, methods which are low-cost, accurate, and automatic or semi-automatic for extracting these parameters are limited. We present here semi-automatic techniques for this purpose. They are object-based image analysis (OBIA) and Canny edge detection (CED), using free, very high spatial resolution images from Google Earth. We chose yardang fields in Dunhuang of west China to test the methods. Our results showed that the extractions registered an overall accuracy of 92.26% with a Kappa coefficient of agreement of 0.82 at a segmentation scale of 52 using the OBIA method, and the exaction of yardangs had the highest accuracy at medium segmentation scales (138, 145). Using CED, we resampled the experimental image subset to a series of lower spatial resolutions for eliminating noise. The total length of yardang boundaries showed a logarithmically decreasing (R2 = 0.904) trend with decreasing spatial resolution, and there was also a linear relationship between yardang median widths and spatial resolutions (R2 = 0.95). Despite the difficulty of identifying shadows, the CED method achieved an overall accuracy of 89.23% with a kappa coefficient of agreement of 0.72, similar to that of the OBIA method at medium segmentation scale (138).

Investigating the Effects of Pavement Roughness on Freeway Safety using Data from Five States

Traffic crashes occur usually because of a combination of human, roadway/environment, and vehicle factors. Pavement condition is closely related to these three factors as it is one of the most important roadway/environment factors and it affects driving behavior and vehicle performance at the same time. Previous studies have shown that pavement condition plays an important role in safety. This study develops four different safety performance functions to evaluate the effect of pavement roughness, measured by the International Roughness Index (IRI), on the number of crashes using the interstate highway data from five U.S. states representing different geographical and weather regions: Arizona, Colorado, Florida, Maryland, and Michigan. The modeling results identify many significant variables including traffic volume and proportion of trucks, through lane count, shoulder type, median width, high-occupancy vehicle (HOV) lane operation and HOV lane count, speed limit, area type along with IRI-related factors. The results indicate that increased IRI (deterioration of pavement quality) contributes to large numbers of total crashes. On interstate highways with speed limits of 70 mph and higher, the effects of IRI are relatively smaller. On the other hand, the effects of IRI increase with a larger traffic volume. Based on the modeling results, seven crash modification functions of IRI values by crash type and speed limit were estimated. The findings from this study are expected to be useful for both pavement and safety engineers to understand the relationship between IRI and safety on freeways.

Clinical and imaging evaluation of Congenital Midnasal Stenosis

ObjectivesTo illustrate the clinical and radiological presentation of a rare etiology of nasal obstruction in neonates, midnasal stenosis (MNS), including a comparison of nasal dimensions with those of normal infants. MethodsWe retrospectively reviewed medical charts and computerized tomography (CT) imaging of neonates with nasal obstruction diagnosed as stenosis in the midnasal area in a tertiary pediatric medical center. MNS was defined clinically by inability to visualize the middle turbinate with an endoscope despite the absence of stenosis of the anterior aperture or any gross septal deviation. CT measurements of the midnasal width were taken by an experienced neuroradiologist. We compared widths between the bony inferior turbinate to the bony septum in the narrowest area of symptomatic patients, to widths in a control group of asymptomatic children. ResultsNine neonates from birth to three months old presenting with nasal obstruction, severe stertor, and blocked nasal passage at the midnasal level in endoscopic examination, were diagnosed with MNS. 6/9 had CT scans. Four had isolated unilateral stenosis, two unilateral MNS and contralateral choanal atresia, and three bilateral MNS. All patients were managed conservatively, initially with nasal saline irrigation and local steroids and topical antibiotics; Median time to resolution of symptoms was 14 days.When comparing the dimensions at the midnasal narrowest area of the stenotic group with a control group of 139 healthy children, the median bony width was 1.7 mm vs. 3.2 mm, respectively (p < 0.00001). Average dimensions according to age groups until the age of 12 months are given. ConclusionIn neonates with nasal obstruction, when choanal atresia and pyriform aperture stenosis are excluded, stenosis of the midnasal area should be considered. Most of these neonates can be managed conservatively. Level of evidence4.

Individual and Population Benefits of Marine Reserves for Reef Sharks.

No-take marine protected areas (MPAs) are a commonly applied tool to reduce human fishing impacts on marine and coastal ecosystems. However, conservation outcomes of MPAs for mobile and long-lived predators such as sharks are highly variable. Here, we use empirical animal tracking data from 459 individual sharks and baited remote underwater video surveys undertaken in 36 countries to construct an empirically supported individual-based model that estimates the conservation effectiveness of MPAs for five species of coral reef-associated sharks (Triaenodon obesus, Carcharhinus melanopterus, Carcharhinus amblyrhynchos, Carcharhinus perezi, and Ginglymostoma cirratum). We demonstrate how species-specific individual movement traits can contribute to fishing mortality of sharks found within MPAs as they move outside to adjacent fishing grounds. We discovered that the world's officially recorded coral reef-based managed areas (with a median width of 9.4 km) would need to be enforced as strict no-take MPAs and up to 5 times larger to expect protection of the majority of individuals of the five investigated reef shark species. The magnitude of this effect depended on local abundances and fishing pressure, with MPAs required to be 1.6-2.6 times larger to protect the same number of Atlantic and Caribbean species, which occur at lower abundances than similar species in the western Pacific. Furthermore, our model was used to quantify partially substantial reductions (>50%) in fishing mortality resulting from small increases in MPA size, allowing us to bridge a critical gap between traditional conservation planning and fisheries management. Overall, our results highlight the challenge of relying on abundance data alone to ensure that estimates of shark conservation impacts of MPAs follow the precautionary approach.

Quality of Life after Complex Abdominal Wall Reconstruction

Background: Component separation (CS) for tension-free approximation of fascial edges is the established technique for the repair of large ventral hernias mostly regarding midline defects. Recent studies suggest lower complication rates following a modified version of this technique using a partially endoscopic-assisted approach, whereas little is known about the quality of life (QoL) in the long-term evaluation of these patients. Methods: A retrospective study and analysis of patients undergoing hernia repair using an open CS (OCS) and endoscopically assisted CS (ECS) technique, respectively, from 2011 to 2016 at the Rostock University Medical Center. Patients underwent a mesh-based sublay reinforcement following a distinct CS with closure of the linea alba. Patient characteristics, technical details, and short-term postoperative outcomes were determined by a physician chart review. A health-related QoL survey (EQ-5D) including a pain assessment was evaluated at a median of 19.5 months postoperatively. Results: Thirty-five patients had a CS: 25 OCS and 10 ECS. Perioperative variables were comparable except for the median defect size (169 cm² OCS vs. 86 cm² ECS; p < 0.05) and maximum width of hernia (25 vs. 13 cm). Hospitalization lasted 16.6 days in the OCS group and 7.9 days in the endoscopic group (p = 0.04). Wound complications occurred in 24% of OCS and 10% of ECS patients. Conclusions: Patients in the ECS group had a shorter hospital stay and less minor and major wound complications. These advantages led to a faster recovery directly affecting the QoL in the ECS group. This effect diminishes in the long-term follow-up with a positive trend towards the OCS technique.

Perception of Labial Size and Objective Measurements-Is There a Correlation? A Cross-Sectional Study in a Cohort Not Seeking Labiaplasty

IntroductionPoor genital self-image is a common phenomenon leading to an increasing interest in female genital surgery over the last years. AimThe aim was to correlate objective measurements of the labia minora with the individual subjective perception of the labial size. MethodsIn a cross-sectional study with 200 premenopausal women (median age 33.5 years) presenting for gynecological issues other than vulvar diseases, labial width and length were measured, and psychological and physical complaints were assessed. Multivariable logistic regression analyses were performed to identify factors that influenced self-reported complaints and subjective perception of labia size. Main Outcome MeasureThe main outcome measure was labial appearance (width and length in mm, color), subjective perception of the labial size, and complaints. ResultsThe median width of the labia minora was 19.0 mm (interquartile range = 12.6–27.5), and the median length was 35.5 mm (interquartile range = 27.8–48.9). The objective size of the labia was significantly associated with womens' subjective perception of the labial size, but not with self-reported complaints. Nearly one-third of the women (n = 53, 27%) reported complaints of their labia minora which were mainly physical (n = 41, 77%) or a combination of physical and psychological problems (n = 9, 17%), while only a small group reported experiencing only psychological complaints (n = 3, 6%). Predictors of complaints were previous cosmetic surgery and the subjective perception of the labia size. The latter was significantly associated with discomfort during intercourse and when visiting a sauna and by labia minora that protruded over the labia majora. Clinical ImplicationsCutoff values to define labial hypertrophy and to justify labial reduction surgery should be avoided. Strength & LimitationsThis is a large sample of labial measurements in women not seeking labiaplasty. Standardized and validated questions regarding quality of life, sexuality, and body image could have provided more insight into psychological aspects. ConclusionThese data demonstrate the variability of labial anatomy and its perception.Widschwendter A, Riedl D, Freidhager K, et al. Perception of Labial Size and Objective Measurements-Is There a Correlation? A Cross-Sectional Study in a Cohort Not Seeking Labiaplasty. J Sex Med 2020;17:461–469.

The effect of median opening on traffic characteristics on the arterial street

Pettarani street is equipped with a median opening as a facility for vehicles to reverse the direction of travel. The median opening width in the Pettarani section varies between 20 m - 37 m. The wideest median opening width in Badan Pertanahan / LPMP segment, while the narrowest median opening width is The Mutiara segment. The largest traffic volume that merged in the median openings of Pettarani street for morning peak hour 1816 pc/h in HM. Asyik Mosque and Telkom segments (Pettarani S-S). For afternoon peak hour with a value of 1802 pc/h. The median opening segment HM. Asyik Mosque has the highest density value, which is 17 pc/km/ln in the morning and 16 pc/km/ln in the afternoon. The highest density value for diverging movement is 32 pc/km/ln occurs at HM Asyik Mosque median opening segment. The wider the median opening results in increased density, this is due to increased space for the vehicle to do a reverse rotation maneuver, thus increasing movement disturbances for opposite flow and flow behind the vehicles that will do reverse rotation. The greater the volume in the main section the more it affects the movement of vehicles that are in the median opening to do merging and diverging, thereby increasing density.

HSP70 drives myoblast fusion during C2C12 myogenic differentiation.

ABSTRACTIn response to injury, skeletal muscle stem cells (MuSCs) undergo myogenesis where they become activated, proliferate rapidly, differentiate and undergo fusion to form multinucleated myotubes. Dramatic changes in cell size, shape, metabolism and motility occur during myogenesis, which cause cellular stress and alter proteostasis. The molecular chaperone heat shock protein 70 (HSP70) maintains proteostasis by regulating protein biosynthesis and folding, facilitating transport of polypeptides across intracellular membranes and preventing stress-induced protein unfolding/aggregation. Although HSP70 overexpression can exert beneficial effects in skeletal muscle diseases and enhance skeletal muscle repair after injury, its effect on myogenesis has not been investigated. Plasmid-mediated overexpression of HSP70 did not affect the rate of C2C12 proliferation or differentiation, but the median number of myonuclei per myotube and median myotube width in differentiated C2C12 myotubes were increased with HSP70 overexpression. These findings reveal that increased HSP70 expression can promote myoblast fusion, identifying a mechanism for its therapeutic potential to enhance muscle repair after injury.This article has an associated First Person interview with the first author of the paper.

Identifying infrastructure risk factors in Africa

The paper aims to provide a critical overview of the infrastructure risk factors in African countries performed within the research project "SaferAfrica - Innovating dialogue and problems appraisal for a safer Africa". The project is funded by the European Commission’s Horizon2020 research and innovation programme. Both macroscopic (generic level) and microscopic (infrastructure element level) potential risk factors were examined and discussed. The macroscopic infrastructure risk factor analysis was based on WHO mortality data and revealed a weak but existent relationship between an extensive road network and fatality rates in African countries. On the other hand, the microscopic infrastructure risk factors analysis, based on technical reports and scientific papers, showed various potential factors, such as low road width, curve radius, low median width, absence of street light etc. Although some research has been carried out in the field of infrastructure risk factors and road safety, the major identified drawback is the lack of available data. Therefore, it is strongly suggested to validate the empirical findings with real-African data. Such an analysis accompanied with reliable and accurate data consists the basis for identifying priority areas for road safety actions and interventions.

Negative Pressure Wound Therapy in Surgical Wounds - A Single Centre Experience

Background: Negative pressure wound therapy (NPWT) is a therapeutic technique using suction pump to promote healing of wound. It can be used in a variety of surgical wounds. The aim of the study was to evaluate the outcome of NPWT in different types surgical wounds in a district general hospital (DGH)with a view to identify the complete healing rate of surgical wound and complication rate of using this technique. Method: A retrospective review on prospectively-collected data of 102 patients was conducted from January 2018 to September 2019. Demographic data, diagnosis, comorbidities, indications for the application of NPWT, duration of therapy were recorded. Outcome included rate of complete healing and complications. The exclusion criteria were patients from other non-general surgical specialties and patients with bed sores. Result: 102 patients (M: F 40:62) with a median age of 61 (30-96) years were included in the study. Median Body Mass Index (BMI) of patients was 27(19.2-44). 26.4%, 63% and 11.8% had a BMI less than 25, between 25-35 and above 35 respectively. The NPWT application was mostly (71.5% n= 73) used for anterior abdominal. Wound dimensions revealed a median length of 8 cm (range 3-20) and median width of 5cm (range 1-31). 98(96.1%) patients had complete healing and four patients (3.9%) had recorded complications. Conclusion: From our experience, the use of NPWT achieved excellent complete healing rate with a very low complication rate. We can conclude that NPWT is a very useful, safe and effective technique to manage surgical wounds.

Factors affecting elasmobranch escape from turtle excluder devices (TEDs) in a tropical penaeid-trawl fishery

The use of turtle excluder devices (TEDs) has resulted in fewer elasmobranchs (i.e. sharks and rays) caught in tropical penaeid-trawl fisheries. However, very few studies in the primary literature have quantified the effects of various TED design aspects affecting the escape of elasmobranchs. Data collected by observers on board commercial trawlers operating in Australia’s northern prawn fishery (NPF) during 2001 were re-examined to quantify the effect of TEDs on catches of various elasmobranchs. During this sampling, a total of 6204 elasmobranchs were caught from 1440 net trawls. The 34 species identified, from 15 families and four taxonomic orders, were dominated by small carcharhinids (n = 2160, median total length = 75 cm) and dasyatids (n = 2030, median disc width = 24 cm). The TEDs assessed significantly reduced the numbers of large elasmobranchs caught: increasing fish size was found to result in higher escape for all taxonomic orders. Further, top-shooter TEDs increased the escape of Carcharhiniformes, while bottom-shooter TEDs facilitated greater escape of Myliobatiformes. Grid orientation had no effect on the escape of Orectolobiformes or Rhinopristiformes. Decreasing bar space was found to increase the escape of only one species, the Australian blacktip shark (Carcharhinus tilstoni). The TEDs facilitated the escape of several species of conservation interest including the globally endangered scalloped hammerhead (Sphyrna lewini) and zebra shark (Stegostoma fasciatum). However, the rostrum of the narrow sawfish (Anoxypristis cuspidata) inhibited the escape of this globally important species. Fishery-specific research is required to determine the appropriate TED bar spaces that reduce catches of elasmobranchs while minimising the loss of commercially important species.

Carbazole-tagged pyridinic microporous network polymer for CO2 storage and organic dye removal from aqueous solution

A microporous organic polymer (Cz-pyr-P) was prepared from a monomer of pyridine-imides, flanked by four carbazoles, and its application as an adsorbent for both CO2 and methylene blue dye in wastewater was investigated. The polymer was synthesised by oxidative polymerisation facilitated by FeCl3 and comprehensively characterised using routine spectroscopic, thermal, textural, and morphological analyses. With a high surface area of 1065 m2/g and a median pore width of 8.06 Å, the nitrogen-enriched Cz-pyr-P reversibly adsorbed 19.41 wt% (273 K) and 12.78 wt% (295 K) CO2 at 1 bar, with a good isosteric heat value of CO2 adsorption (28.5 kJ/mol). For the removal of methylene blue dye from wastewater, Cz-pyr-P exhibited excellent partition coefficient of 380.10 mg/g μM with an equilibrium time of 6 min which is shorter than previously reported values for other materials. The results indicate that Cz-pyr-P with desirable functionality could be utilised for reaching CO2 emission reduction targets as well as for wastewater treatment.

DW-MRI predictive factors for radiation-induced vaginal stenosis in patients with cervical cancer

To find diffusion-weighted (DW) magnetic resonance imaging (MRI) parameters predictive for radiation-induced vaginal stenosis (VS) in locally advanced cervical cancer (LACC) treated with neoadjuvant chemoradiation therapy (CRT). Retrospective analysis of 43 patients with LACC who underwent 1.5 T DW-MRI before (baseline), after 2 weeks (early), and at the end of CRT (final). At MRI, vaginal length, thickness, width, and cervical tumour volume (TV) were measured. Vaginal signal intensity at DW-MRI was analysed at final MRI. CRT-induced VS was graded using Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Correlations between DW-MRI and clinical data were made using Wilcoxon's test, Mann-Whitney test, Fisher's exact test, or chi-squared test as appropriate. Receiver operating characteristic (ROC) curves were generated for variables to evaluate diagnostic ability to predict CRT-induced VS using a logistic regression model. Asymptomatic vaginal toxicity (CTCAE Grade 1) was observed in 14 patients and symptomatic CRT-induced VS (CTCAE Grade ≥2) was detected in 29 patients. Baseline TV was higher in Grade 1 than in Grade ≥2 (p=0.013). Median vaginal length, thickness, and width decreased between baseline and final MRI in all patients (p<0.0001) without significant variances between CTCAE grades. Significant differences were observed in DW-MRI patterns (p<0.0001). In Grade ≥2, DWI showed signal loss of vaginal mucosa in 17 patients (63%) and diffuse restricted diffusion of vaginal wall in eight patients (30%). AUC was 0.938 (coefficient=4.72; p<0.001) for DWI and 0.712 (coefficient=-2.623×10 -5; p=0.004) for TV. This is the first study using DW-MRI for predicting CRT-induced VS. DWI is useful tool in patients with LACC after CRT for early prevention and management strategies for VS.

Relationship of Accident Rates and Road Geometric Design

Road safety issue has become a major concern worldwide due to the serious consequences of road accidents on countries socio-economics and human lives. The main aim of this paper is to discuss and review the effects of geometric design elements on road accidents including statistical models used over the years and to compare the outcomes of the studies conducted in several countries. A way to improve road safety is improving road geometric design to mitigate accidents occurrence and severity on roadways. In order to improve the road design, it is crucial to evaluate and define the relationship between road geometric design elements and road accidents. Studies have tried to relate road geometric design elements such as lane number, sight distance, super-elevation, median width and type, lane and shoulder width, curve radius, gradient, and horizontal and vertical alignments to accident rates. Due to the interrelations between geometric design elements with each other and with other road accident factors, and also lack of reliable methodology of relationship estimation between road geometric design and safety. Ongoing enhancement of statistical methods has resulted in many road design-accidents analysis models which have been developed using a variety of statistical modelling approaches such as linear regression models, multiple linear regression models, Poisson regression models, Poisson-Gamma models, negative binomial models, bivariate and multivariate models, generalized estimation regression models, random parameters models, etc. However, some limitations have been encountered using the mentioned statistical models, thereby there are opportunities for road safety researchers to overcome the limitation challenges.

Management of Pilonidal Sinus Disease with the Aesthetically Shaped Parasacral Perforator Flap: Multicenter Evaluation of 228 Patients.

The management of pilonidal sinus disease is still not standardized. Currently, the two main procedures are a lay-open excision procedure with secondary healing or coverage with local flaps. The authors present their experience with a one-stage excision-coverage with an innovative parasacral artery perforator flap propeller designed to respect the aesthetic unity of the buttocks. Study patients were managed with this procedure in the Toulouse, Montpellier, and Rennes university hospitals between 2012 and 2018. Data were collected on clinical and surgical details, immediate and late postoperative complications, and long-term recurrence. Aesthetic satisfaction was evaluated with a self-evaluation questionnaire. The authors operated on 228 consecutive patients for pilonidal sinus disease with an aesthetically shaped parasacral artery perforator flap. The median patient age was 23.5 years, the median operative time was 46 minutes, the median flap length was 9.3 cm (range, 6.5 to 14 cm), and the median flap width was 4.1 cm (range, 4 to 6.5 cm). There were five distal necroses but no complete flap necrosis. There were six postoperative hematomas, 11 infections, and 18 wound dehiscences. The median follow-up period was 27.9 months. Median hospital length of stay was 4.2 days. Three recurrences of pilonidal sinus disease and six instances of hidradenitis suppurativa were detected. Approximately 82 percent of the women and more than 85 percent of the men were "satisfied" or "very satisfied" with the aesthetic outcome, without significant differences between the sexes (p = 0.901). The aesthetically shaped parasacral artery perforator flap combines very satisfactory results regarding recurrence and postoperative recovery with cosmetic outcome. This procedure is technically more demanding than other flap procedures, although it is accessible to numerous surgeons as the first-line treatment for pilonidal sinus disease after initial learning. Therapeutic, IV.

Primary uncomplicated midline ventral hernias: factors that influence and guide the surgical approach.

Considering recently published high-level evidence on the management of primary midline ventral hernias, we set out to review current practices and reevaluate the literature surrounding this topic. The Americas Hernia Society Quality Collaborative (AHSQC) was used to abstract all uncomplicated primary midline ventral hernias. The primary outcomes of interest were surgical approaches, including the use of mesh, the type and position of mesh, and the use of minimally invasive surgery (MIS). A total of 7030 met inclusion criteria; mean age of 52 ± 14, 71% male, with a median hernia width of 2 [1, 2]. A total 69% underwent mesh repair, while 31% underwent suture repair. The most commonly used mesh was permanent synthetic (98%), placed in either the intraperitoneal (46%) or preperitoneal (42%) spaces. The majority of repairs were performed through an open approach (72%). When mesh was used through an open approach (58%), the majority were patches (70%) placed in the preperitoneal space (50%). Through an MIS approach (95%), the majority were flat meshes (53%) placed in the intraperitoneal space (58%). Recent high-level literature recommends the use of mesh repair (flat mesh) in all patients with hernia width ≥ 1cm. This evidence is limited to the use of flat mesh through an open approach. While AHSQC surgeons do offer mesh repair in the majority of cases, this is most commonly using a mesh patch, and is selective towards larger hernias and obese patients. Further research is required to evaluate the safety of mesh patches, and a mesh repair should be offered to a young non-obese healthy patient, as they benefit similarly from the use of mesh.

ANALISIS PERENCANAN PUTARAN BALIK (U-TRUN ) STUDI KASUS : JL. ALAMSYAH RATU PRAWIRA NEGARA KOTA PAGAR ALAM

Transportation problems are problems that are always faced by developed countries and developing countries such as the city of fencealam, both in the economic and social fields. Planning a back-turn (u-turn) vehicle on a median road network greatly influences traffic conditions when the road network has a good performance, many benefits are gained by the community. The advantage is that it increases local income and income, especially for city railings. nature if road service, runs smoothly. The purpose of this study was to determine the dimensions of the median width and the placement of u-turn on the Alamsyah Ratu Prawira Negara City fencealam road segment. Primary data collection is carried out for 2 days, namely Sunday and Monday represents working days, namely Monday morning at 06.00-18.00 WIb The survey data is carried out including calculation of traffic volume, speed, capacity, degree of saturation, level of road service, complication at the intersection. Data analysis was carried out by tabulating data to obtain road characteristics, median ideal width, and total placement. From the results of calculations, the peak hour traffic volume was 183 smp / hour and Monday was 298 pcu / hour.